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s �uOU.N.� CAL SSE REMYT LOG <br /> G`EUINT NAAM: rA S DATE Deceived at tab: nlanry water for <br /> IAC.BY('R]NZ} 3 TIM Rtceivcd at Lab: j L? regi4atory puzposos: Y-ES NO <br /> WO11cORDER: L.'S a 0 LOG Llf D Ty,: wastewater,for <br /> regrxlatory pvrposeg: YES ,-4 <br /> > CIRCLE THE APPROPRIATERE,SPOjNSB LAo <br /> ¢ COIt7A.11IFR <br /> SANMr,# trUMNT M cap rrYON rc. <br /> nxsc; Tzar M' 9A�>��� <br /> I. Custody Se21(s) Present 1 ent -- <br /> Inta.ct/Broken Z ' <br /> 2, Gain-of-Ltod Prese /Absent* 3 y3 <br /> 3. Traffic Reports or <br /> $'eking List_ Present! bsent <br /> A <br /> 4. AIItM: Airbi111 Sacker <br /> P: <br /> es=r/ bscnt <br /> S. Air.HJ.Yk <br /> 6. Sazrz lc Labels: Fres A03CAt y, <br /> ' 7. Sample IX7s: Liste Not Listed - <br /> a:in-of>-Of <br /> S. Sample Condition: jln� ,8rokeu*/ <br /> 9. Does informatia�on <br /> custody rcpor'�s,traXic <br /> zeports and sample <br /> ?abeIs gree? <br /> lo, Samplo scccived within i <br /> hold time: `f /No* <br /> t' 7 <br /> er PrC=rvativas <br /> p Rec.at Lab:nco range fpr samples th=14 pres.:4+/-2°G) DrNtion(if an <br /> *xf Circled contact�'ra`ec�;Y,tnz�a ex amts,atfac�.><•ccoxd oi•resolu#or>;. <br /> ample Rocapt dog <br /> vlslan ze N40isfo 1 <br /> 102) <br /> aces Revlsfon 2 ZI(11/1 MO) Page of <br /> ve D411 X02 <br />